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NPI Code Detail

MEDICARE: KIM D DUTREMAINE LCSW, LADAC

MEDICARE: KIM D DUTREMAINE LCSW, LADAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerC-06585NM
2104100000XSocial WorkerC-06585NM

General Provider Information

NPI Number : 1770739096
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIM D DUTREMAINE LCSW, LADAC
Provider Business Mailing Address
First Line : 653 W ARRINGTON ST
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-8513
Country : US
Telephone Number : 505-564-3733
Fax Number : 505-564-3788
Provider Business Practice Location Address
First Line : 653 W ARRINGTON ST
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-8513
Country : US
Telephone Number : 505-564-3733
Fax Number : 505-564-3788
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2008
Last Update Date : 07/22/2025

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